Is Getting Into the Hair Transplant Field a Wise Decision for a Med Student?

/by William Rassman, M.D./1 /,

Doctor, love the blog, lots of useful information. I was hoping you could give a little career advice. What would you say to the students in medical school interested in getting into the field of hair transplantation? Would this not be a wise decision with companies such as histogen/replicell potentially achieving positive results using non-invasive techniques?

For a medical student thinking of a specialty to choose, I would not recommend hair transplant surgery. Not because it is not a great field, but mainly because there is no formal hair transplant surgery training or residency that would give you the requisite skills you should have. There is no consistency in the field of hair transplantation. I do believe the community of hair transplant doctors is improving and striving for consistency and it has greatly improved in the last decade. In fact, there is a board certification for hair transplant doctors, but it isn’t recognized by the American Board of Medical Specialties (ABMS).

If you still would like to pursue the hair transplant field, I would pursue a ABMS approved residency program of your interest. First get basic training in some official specialty like dermatology, and then get a fellowship under some well recognized expert in the hair transplant field who will take you under his wing.

Tags: hair transplant, medical student, doctor

2 Weeks After My Hair Transplant, I See The Grafts Growing

/by William Rassman, M.D./0 /,

Hello Doctor,
I have undergone HT 2 weeks back with 2 sessions of a total of 5000 grafts done. Till date, I don’t see a single transplanted hair being fallen out. Instead, I see them growing in length. Is this something to be worried?

I’m wondering why would you worry if you are seeing something positive like growth? You must have had a great donor density to get out 5,000 grafts in two sessions.

In general, most people see what appears to be graft growth in the first 2-3 weeks (it is actually the hair in the graft being pushed out of the scalp). As this is actually the shedding process of the hair which is going into telogen, most of the transplanted hairs will fall out in one month. Either way, follow up with your doctor as he/she can better assess your post operative course and progress.

Tags: hair transplant, hairloss, hair loss, hair growth

In the News – Latisse for Scalp Moves into Phase 2

/by William Rassman, M.D./2 /

Snippet from the article:

Allergan Inc. has moved its eyelash treatment into the second clinical stage of testing as a therapy for baldness and expects to see data by the middle of next year, Chief Executive Officer David Pyott said.

The product, Latisse, was approved in 2008 to aid in eyelash growth, and generated $82 million last year for the Irvine, California-based company. Allergan is currently testing Latisse for men and women against placebo. U.S. regulators generally require three stages of trials before approval.

Read the full story — Botox-Maker Allergan Tests Eyelash Lengthener for Baldness

I know the cost for Latisse as it is right now would be pretty steep for use on the scalp, since it is packaged in small quantities for use in eyelash growth. If this proves successful in treating scalp hair loss, I’m sure that will change. We’re still a way off from that, though.

Tags: allergan, lumigan, latisse, hairloss, hair loss, clinical trial

Years After I Stopped Propecia, My Hairline Is Thicker and Keeps Growing

/by William Rassman, M.D./4 /

Hi i have a somthing weird going on here. i started propecia in year 2001 because i had a receding hairline and my crown was very thin. After a year on the drug i stopped using it because it was too expensive and i only saw a little change. on month 3 without propecia my hair was very bad but i gave up and didnt care.

in 2009 my wife asked me “have you got a hair transplant or something?” i looked in the mirror and i could actually see there was something going on, but i just thought i had a good hair day. my hair just keep on growing and my hair seem better and better. what is going on? my hairline has moved a whole inch down from before propecia, and my hair is getting thicker and i dont have hair loss in temples anymore. you cant really see i have hairloss anymore. everybody thinks i got a transplant or wearing a toupee, but im not. How can this happen?

I have never heard a story like that before, so I can not comment on it. What you’re describing is highly unusual. Do you have pictures to compare where you were and where you are now?

Tags: propecia, finasteride, hairloss, hair loss

Is There a Way to Determine If You Will Eventually Have MPB at Some Point?

/by William Rassman, M.D./0 /

Is there any way whatsoever to determine whether a person will at some point in their lives suffer from male pattern baldness, and if so, would this not eliminate the problem of transplanting people too young (say if they have a naturally high/ uneven hairline etc)

There is a test called HairDX that will tell you if you have the gene (70% accurate), but it won’t tell you when that gene will be expressed… or if it will be expressed at all. So on a predictive basis, the answer is unfortunately no. But if you want to know if you are balding (possibly just a little) then you should see a doctor who is experienced in hair analysis for miniaturization and hair bulk, which this will tell you if the balding process has started in you.

Many young men with a balding dad or uncle or brother are expecting hair loss to happen to them, and these are the patients I can help by telling them what, if anything, is going on in their head. If you have an average hair thickness, you might not see thinning until the hair loss is at 50% of the original density. Coarser haired men will often not detect loss even at 60-70% of their original density and blond men may not detect hair loss or thinning to 80-90% of the hair due to the low contrast between hair and skin color.

Tags: hairloss, hair loss, predicting, mpb, hairdx

If Propecia Lowers DHT Levels, Why Does It Take Months to Show Benefits?

/by William Rassman, M.D./0 /

Hello,

Could you please explain why propecia does not stop hair loss a lot more quickly? I thought it lowers the dht levels straight away so surely this should stop the hair loss.

Reversing the balding process takes time as the drug works slowly on the hair generating mechanism. Even if it fully worked in a day (ridiculous as this sounds), the hair grows from the scalp at a rate of 1/2 inch per month, so to see benefit for hair that is 2 inches long, you would have to wait at least 4 months.

Assuming that each month adds strength to the follicular generating system, and the delays in the time for the hair to grow out 2 inches, I would not be surprised to see the reports that it takes between 1 year to maybe even 2 years to see the full benefit of the process. This is, of course, what we see.

Tags: propecia, hair growth, dht, finasteride

SMP at Nape of the Neck?

/by William Rassman, M.D./1 /

Have you done any SMP cases for the nape area or for patients with retrograde alopecia?

We have not performed SMP to the nape of the neck. We can grade the size and shade of the pigment to blend so that the nape of the neck will appear finer than the scalp hair. I see no reason why it would not work as long as the haircut can match the buzzcut look.

Tags: pigment, scalp micropigmentation, micro-pigmentation, neck

Does Finasteride Work Better For Some Races?

/by William Rassman, M.D./0 /

Hi, Dr. Rassman!

I am of asian race, and I’m experiencing great progress with finasteride, greater than in most of cases I’ve read. Since almost all users of finasteride I know are white, I wonder: Does finasteride work better in asian men?

I wouldn’t assume finasteride response is related to race. Based on what I have observed for over a decade of treating patients with this drug, there is no pattern on race.

Tags: finasteride, race, asian, hairloss, hair loss

SMP for Young Patient with Hairline Corner Recession?

/by William Rassman, M.D./1 /

Would you perform SMP on a young patient with a receded hairline just to fill in the receded corners, if he still wish to keep his hair longer? I mean to the point where these areas are covered anyway, to allow the option of shaving the head in future, or just to provide more coverage if the comb forward isn’t cutting it? I’m talking no more than an inch of recession either side.

If you are considering Scalp MicroPigmentation (SMP) then you should be prepared to keep your hair cut short (buzzcut with no guard). If the bald area is covered anyway, I’m not sure why you’d want to have it done. If it’s not covered, the hair should be kept clipped short to keep the pigmented area from looking abnormal. This might not be the solution for you, since SMP does not usually look as good in the hairline with hair kept long. It may work in certain case by case individuals, but it is not intended for the frontal hairline unless it is worked in conjunction with hair transplants.

SMP is not for a simple quick fix because as a young man, you need to consider more corner recession and possibly significant recession as you get older. This should should be considered permanent, so you would be committed to get more SMP procedures as you continue to bald.

Tags: smp, scalp micro-pigmentation, pigments, hairloss, hair loss, hairline

I Stopped Propecia for a Week and After Restarting I Have Side Effects

/by William Rassman, M.D./0 /

Hi I have been on Propecia for over 5 years with little side effects except a little decreased semen. I missed dosing for over a week because I lost some of the meds. I started shedding alot but restarted my regime. Now I have premature ejaculation and a depressed mood. Is this temporary could stopping for 10 days and restarting have negative effects? Is it normal to shedding that fast from stopping the meds for 10 days? I was getting hand fulls

Your experience of these new side effects and hair loss is very strange only after 10 days of missing the Propecia dose. This drug, although out of the blood stream in 24 hours, remains ‘fixed’ to the tissues inside the cells for as long as a week. I have no answer to your question based upon how I know this drug works.

I would recommend that you follow up with your doctor.

Tags: propecia, finasteride, hairloss, hair loss, side effects

Finasteride and Internal Bleeding?

/by William Rassman, M.D./0 /

Is blood in a person’s stool a possible side effect of taking finasteride?

No. Finasteride does not cause internal bleeding or blood in your stool. In general, blood in a person’s stool can be anything from hemorrhoids to cancer. I would follow up with your doctor.

Tags: finasteride, blood, internal bleeding

Sperm DNA Damage from Finasteride?

/by William Rassman, M.D./8 /

Snippet from the case report:


The significant reduction in DFI within 3 months of finasteride cessation and continued improvement suggests a causal link between finasteride and sperm DNA damage. We hypothesize that low-dose finasteride may exert a negative influence on sperm DNA integrity, resulting in increased pregnancy losses. We suggest that in infertile men using finasteride, sperm DFI should be measured in addition to semen parameters, and a trial of discontinuation of finasteride may be warranted.

Read the rest — Finasteride-induced secondary infertility associated with sperm DNA damage

This is a single case report published earlier this year in Fertility and Sterility about a 48 year old man that shows a casual link between finasteride and sperm integrity. It summarizes that some negative impact of finasteride on sperm’s DNA fragmentation index (DFI) which was reversible with stopping the medication.

I’m asked all the time about finasteride and fertility, and all I can go off of is what is in the literature and from what my patients have told me. I’ve had many male patients with no problems getting their wife/girlfriend pregnant, but perhaps for men who are taking finasteride that wish to conceive children, they should talk to their prescribing physician about discontinuing the medication during the period of the female’s cycle between 11-21 days from the onset of menses. There is no assurance that such a step will address the problem identified in this article or that you will have such an issue to begin with.

Tags: propecia, proscar, finasteride, fertility, hairloss, hair loss, semen, sperm, pregnancy

If Stress and MPB Caused Hair Loss, Could There Be Some Regrowth?

/by William Rassman, M.D./0 /

In response to a recent post about stress hair loss vs genetic causes:

Dr Rassman,

What if it’s both? Then does it take one year still to see atleast a little reqrowth? You say a year, but in other posts you have said 6-12 months. Are you talking about how long it takes to first start growing, or how long it will take for the hairs to reach their previous length? Thanks

These numbers of 6 or 12 months are in the ballpark of what we see. It’s an educated guess based upon experience over a long time frame. Either number works, but clearly, if you see regrowth in 6 months then you’re on the lower end of the spectrum. Some may see regrowth sooner than others, but there’s no exact date one can mark on the calendar.

If you have stress induced hair loss AND genetic male pattern baldness, the stress might speed up the existing genetic loss. I really have no way to know if there will be regrowth (or how much) after your stress is under control if you have MPB also at play.

Tags: stress, hairloss, hair loss

FUE Doctors in New England?

/by William Rassman, M.D./1 /

Do you have any recommendations for talented FUE surgeons in the New Hampshire area? Thanks so much!

I don’t have any personal recommendations for New Hampshire or anywhere in New England. The only hair transplant doctor I can endorse in the area is in NY.

Dr. Robert Bernstein, who I have personally worked with for over 15 years, is one terrific surgeon. He informed me that he just purchased the ARTAS hair restoration robot that we’ve written about.

Tags: follicular unit extraction, fue, hair transplant, new england, new york

In the News – Fat Cells and Hair Growth

/by William Rassman, M.D./3 /

Snippet from the article:

A hat may no longer be the only answer for baldness. Researchers at Yale University have found new clues to the causes of hair loss in the fatty skin cells of mice.

Studying cells from the fatty layer, the researchers found that signals from these fat cells were needed to stimulate the stem cells at the base of hair follicles, which are dormant in baldness. These cells could help scientists identify how to treat hair loss in humans.

“The fat cells are important for hair growth. If they’re not there, the hair won’t grow,” said Valerie Horsley, the lead author of the study.

Horsley said her team will now work on identifying the cells in humans that do the same thing.

Read the rest — Going Bald? The Fault May Lie in Your Cells

It’s another mice study, but it’s at least a place to start. As the article points out, hopefully it’ll lead to new discoveries not only for hair loss, but wound healing and skin tumors.

Tags: fat, hairloss, hair loss, mice, mouse